| Chc Of Snohomish County 112th Medical | |
|
1019 112th St Sw Everett WA 98204 | |
| (425) 551-6200 | |
| (425) 551-6017 |
| Full Name | Chc Of Snohomish County 112th Medical |
|---|---|
| Speciality | Clinic/Center |
| Location | 1019 112th St Sw, Everett, Washington |
| Authorized Official Name and Position | Robert C Farrell (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4257893700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chc Of Snohomish County 112th Medical Po Box 13060 Everett WA 98206-3060 Ph: (425) 789-3700 | Chc Of Snohomish County 112th Medical 1019 112th St Sw Everett WA 98204 Ph: (425) 551-6200 |
| NPI Number | 1669504395 |
|---|---|
| Provider Enumeration Date | 03/09/2007 |
| Last Update Date | 08/12/2011 |
| Medicare PECOS PAC ID | 0446152003 |
|---|---|
| Medicare Enrollment ID | O20070717000736 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669504395 | NPI | - | NPPES |
| 7034036 | Medicaid | WA | |
| 8934243 | Other | WA | CRIME VICTIMS COMP |
| 32770 | Other | WA | WORKER COMPENSATION |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 7034036 (Washington) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 7034036 (Washington) | Primary |
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